Even in societies that value pregnancy highly, the position of a pregnant woman is not always enviable. A social environment that accords poor status to women generally also tends to marginalize pregnant women. An extreme expression of this is violence against women, a major public health challenge all over the world (
54). Women abused during pregnancy are at increased risk of miscarriage, murder and suicide, and their babies are prone to low birth weight and fetal distress (
105).

Since the United Nations International Conference on Population and Development (ICPD) Programme of Action in 1994, many countries have elaborated or refined their laws to support the ICPD goals. For instance, many countries have passed laws criminalizing violence against women, and several have passed legislation outlawing female genital mutilation. As these laws are gradually implemented, they serve to protect girls and women who are pregnant, but also to promote their overall health.

Protection for women who are pregnant cannot be provided without the support of a legal and policy framework. Some of the most obvious laws and policies include establishing a minimum age for marriage, criminalizing violence against women, prohibiting harmful practices such as female genital mutilation, and enforcing birth registration. All countries have ratified at least one (and many have ratified all) of the international human rights treaties. These place the legal obligation on countries to take measures to ensure that their citizens’ rights are protected and fulfilled, and provide a starting point for effective protection.

Based on such frameworks, a wide range of specific legal and regulatory measures can be taken to improve the protection of women who are pregnant. These rights include the provision of information on sexual and reproductive health, establishing mandatory routine audits and reviews of maternal, perinatal and neonatal deaths, and legal measures for the financial protection and support of pregnant women. The latter concern coverage of medical expenses as well as measures to guarantee their income.

The International Labour Organization’s Maternity Protection Convention (adopted in 1919 and last revised in 2000) sets a minimum standard for what should be included in national legislation in this regard (
106). The Convention provides for protection against dismissal of women during pregnancy, maternity leave and the breastfeeding period, and also for cash benefits. It encompasses coverage of antenatal, childbirth and postnatal care and hospitalization care when necessary, and working hours and tasks that are not detrimental to mother or child. It calls for 14 weeks of maternity leave, of which six weeks must be postnatal leave to safeguard the health of mother and child. This aspect of the Convention covers all married and unmarried employed women, including those in unusual forms of dependent work. This can be interpreted broadly to cover women in all sectors of the economy, including the informal sector, but in practice legislation usually covers only women who are employed in the formal sector. With increasing urbanization and the development of the formal economy, compliance with these minimum standards is increasingly becoming an issue, in developing as well as developed countries.

On the other hand, existing laws, policies and regulations that limit access to health services for unmarried women or for those under a certain age, effectively screen out many women in need. The same is true for services that require up-front payment and exclude those too poor to pay. There are still health services that require third-party authorization (usually by a husband) for treating a woman, pregnant or not, even if no such requirement exists in the national law. If all women who are pregnant are to be protected, these kinds of situations need urgent attention, which often requires the revision of policies and regulations. Environmental, social and legal circumstances can be unfavourable for pregnant women. Referring to the overarching human rights frameworks can do much to eliminate sources of social exclusion, and is as important as providing antenatal care.

Footnotes

54 World report on violence and health. Geneva, World Health Organization, 2002.